Background: The DMPPT has
been used to estimate impact and costs for VMMC programs in many countries. The
model and the resulting plans have focused on men ages 15-49 but recent experience
shows that most clients are under age 25. Should programs adjust demand
creation efforts to focus on older men? The USAID- and PEPFAR-funded Health
Policy Project constructed a model to examine the impact and cost of focusing circumcision
services on different age groups and regions.Methods: The model
uses local patterns of HIV incidence and circumcision prevalence by age and VMMC
efficacy information from clinical trials data to determine the effects of
circumcision on HIV incidence. It then calculates the effect of changing
circumcision rates on incidence in each age group. The circumcision effects are
traced through time as men age and become infected or remain uninfected. Secondary
effects on women are also included. The cost of circumcision varies by age
depending on the cost of the procedure and the cost of recruiting new clients.Results: In the short
term, circumcising men ages 20-34 will be most effective because that is when
most new infections occur. In the long term, younger men would benefit most
because a person circumcised at age 20 will be protected through 20 years of
high incidence (ages 20-39) while a person circumcised at age 35 will only be
protected through 5 years of high incidence (Figure 1). Neonatal circumcision
provides lifetime protection, but since the benefits are delayed by 20 years this
may not be the most cost-effective option unless costs are significantly lower than
adult circumcision and discount rates are low.

[DMPPT 2.0 Illustrative Results]

Conclusions: Male
circumcision programs do not need to make special efforts to recruit older men.
They are already reaching the most appropriate age groups to maximize impact
and cost-effectiveness.Download the e-Poster